Exam 2 - cardiac disorders Flashcards
what is cardiac tamponade (pericardial effusion)
accumulation of fluid in the pericardial sac
causes extreme pressure on the heart, prevents ventricles from fulling expanding
s/sx of cardiac tamponade (pericardia effusion)
CP
confusion
anxiety
restlessness
tachycardia (d/t low CO)
tachypnea (d/t low CO)
JVD
muffled heart sounds
narrow PP
Becks Triad r/t cardiac tamponade complications
low BP
muffled heart sounds
JVD
Becks Triad can lead to what emergency procedure
pericardiocentesis
what is cardiomyopathy
diseased heart muscle
heart is enlarged and thickened
what are the 3 types of cardiomyopathy
dilated
hypertrophic
restrictive
cardiomyopathy causes a ___ in pumping ability which leads to ___ ___; eventually leading to ___ backing up into the ___
decrease
heart failure
blood; lungs
most common type of cardiomyopathy
dilated
what occurs with dilated cardiomyopathy
ventricle dilation
impaired systolic function
enlarged atrium
blood stasis in L ventricle
diminished ctx of muscle fibers
myocardial cell necrosis
causes of dilated cardiomyopathy
pregnancy
HTN
alcohol abuse
viral infections
chemo meds
myexedema
persistent tachycardia
thyrotoxosis
Chagas disease
s/sx of dilatedcardiomyopathy
dyspnea at rest
orthopnea
N/V/A
crackles
edema
JVD
weak peripheral pulses
stasis, clots
s/sx of dilated cardiomyopathy as disease progresses
dry cough
palpitations
N/V/A
bloating
dilated cardiomyopathy treatment
tx underlying disease
HF
ventricular support device
transplant
home health
hospice
leading cause of dilated cardiomyopathy death
ventricular dysrhythmias
what is hypertrophic cardiomyopathy
autosomal dominant genetic disorder
increase heart muscle size and mass
is hypertrophic cardiomyopathy a systolic or diastolic dysfunction
diastolic from L ventricle stiffness
decrease ventricle filling = decrease CO (especially during exertion)
when is hypertrophic cardiomyopathy usually dx
young adults and athletic individuals
what is the most common cause of death in otherwise healthy individuals
hypertrophic cardiomyopathy
what is restrictive cardiomyopathy
diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch
what are the 4 types of restrictive cardiomyopathy
infiltrative disease
storage disease
non-infiltrative
endomyocardial
causes of restrictive cardiomyopathy
myocardial fibrosis
hypertrophy
amyloidosis
endocardial fibrosis
radiation to throax
generalized s/sx of cardiomyopathy
CHF s/sx
CP
palpitations
dizziness
nausea
syncope with exertion
reasons for a heart transplant
cardiomyopathy
ischemic heart disease
valve disease
congenital heart defect
rejection of previous heart transplant
most common procedure for heart transplant
orthotropic transplantation (bicaval technique)
what occurs with orthotropic transplantation (bicaval technique)
receipients heart is removed, portion of atria is left in place with vena cava and pulmonary veins
3 post-transplant drug classes
corticosteroids (prednisone)
calcineurin inhibitors (tacrolimus, cyclosporine)
antiproliferative (mycophenolate, mofetil, azathioprine, sirolimus)
post-transplant medication risk factors
skin, lip cancer
weight gain, obesity
DM
dyslipidemia
kidney failure
HTN
GI disturbances
respiratory problems
medication toxicity
heart transplant complications
HTN
risk for osteoporosis
infection
rejection (quickly - years later)
psychosocial issues r/t heart transplant
increase quality of life
fear of heart rejection
feelings of guilt
indebtness to donor
can a person experience angina post heart transplant
No d/t to nerve connection
are atropin and digoxin effective after a heart transplant
No
what does a ventricular assist device (VAD) do
circulates as much blood per minute as the heart
can be internal or external
what are the 4 types of VAD
pneumatic
electric or electromagnetic
axial flow
centrifugal
what is the main concern with VAD
pump thrombus formation
what can be used with VAD when the lungs fail to oxygenate
ECMO
pulmonary edema is known as
decompensated heart failure
what occurs with pulmonary edema
L ventricle fails, blood backs up into lungs
does pulmonary edema occur quickly or slowly
can be either
quickly is known as flash pulmonary edema
s/sx of pulmonary edema
restless
anxious
sudden SOB
sense of suffocation
tachypenic with low O2 SAT
cyanotic, pale
cool, clammy
JVD
tachycardia
confusion
increase quantities of foamy sputum
what is infective endocarditis (IE)
infection of endotheial surface (endocardium)
injury leads to clot formation, infection invades clot, invaded clot continues to expand and concealed by bodies natural defenses
IE is commonly caused by which bacterias
staph
strep
s/sx of IE
fever, chills
weakness, malaise, fatigue
anorexia, weight loss
abdominal discomfort
clubbing
HA
arthralgia
dyspnea
CP
sharp LUQ pain, spleenomegaly
flank pain, hematuria
decrease LOC
vascular s/sx of IE
splinter hemorrhages
petechia
osler nodes
janeway lesions
roth’s spots
what are osler nodes
small, painful nodules on pad of fingers, toes
what are janeway lesions
irregular, red or purple, painless flat macules on palms, fingers, hands, soles, toes
what are roth’s spots
hemorrhage with pale centers causes by emboli observed in fundi of eye
what s/sx to monitor for with IE
s/sx of stroke
to Dx IE, pt must have 2+ of which 3 tests
2 positive blood cultures 12 hours apart
intracardial mass, vegetation on echo
TEE
what is needed prior to dental procedures to prevent IE after a heart transplant
prophylactic abx
what is myocarditis
inflammation of myocardium
what can causes myocarditis
viral, bacterial infections
fungi
radiation induced
chemical, pharmacological agents
what is the most common cause of myocarditis
coxsackie A & B virus
early s/sx of myocarditis
fever
fatigue, malaise
pharyngitis
dyspnea
N/V
lymphadenopathy
what occurs with myocarditis 7-10 days after viral infection
effusion
pericardial friction rub
late s/sx of myocarditis
CHF
JVD
S3
syncope
angina
peripheral edema
only definitive way to Dx myocarditis
MRI
other ways to Dx myocarditis
EKG with ST changes
elevated WBC, CRP, ESR
myocarditis treatment
abx
limit physical activity
TED hose
Can a person with myocarditis take NSAIDS
No
what to monitor for if a person has myocarditis and takes digoxin
digitalis toxicity
new arrhythmia, A/N/V, HA, malaise
what is pericarditis
pericardial inflammation
what is the cause of pericarditis
unknown but may be viral, bacterial, or fungal
when does acute pericarditis occur
48-72 hours post MI
what occurs with acute pericarditis
sac inflamed > leaks fluid (pericardial effusion)
what is Dressler syndrome
pericarditis that occurs 4-6 weeks after MI
late pericarditis
what test is used to confirm pericarditis
EKG
pericarditis s/sx
severe, sharp CP with deep inspiration and lying flat (pain can radiate to neck, L shoulder and upper back)
dyspnea
pericardial friction rub
hallmark s/sx of pericarditis
pericardial friction rub
when is pericardial friction rub heard best with pericarditis
holding breath while leaning forward
what position is used to relieve pericarditis CP
sitting up, leaning forward
pericarditis complications
pericardial effusion
cardiac tamponade
Becks Triad
pulseless paradox
what is pulseless paradox
drop in BP by 10 mmHg with inspiration
must note the pressure heard on expiraiton
pericarditis treatment
pericardiocentesis
abx
tx underlying cause
NSAIDS
corticosteroids
colchine
what occurs with mitral stenosis
decrease blood from from L atrium to L ventricle
causes a pressure difference during diastole
mitral stenosis put a person at risk for which cardiac dysrhythmia
afib
where is a diastolic murmur heard with mitral stenosis - 2 locations
L sternal border
R 2nd ICS
pt must lean forward and hold breath
mitral stenosis s/sx
SOB with exertion
loud S1 murmur
hemoptysis
CP
emboli
fatigue
palpitations
hoarseness
mitral stenosis treatment
surgical splinting
valve replacement
inoue technique
what is mitral regurgitation
blood from from L ventricle back into L atrium
incomplete valve closure during systole
what are the 2 types of mitral regurgitation
acute, chronic
acute mitral regurgitation can lead to what if left untreated
cardiogenic shock
acute mitral regurgitation s/sx
thready pulse
cool, clammy extremities
chronic mitral regurgitation early vs progressive s/sx
early: fatigue, weak, palpitations, dyspnea
progressive: orthopnea, noctural dyspnea, peripheral edema
an audible S3 is heard where with chronic mitral regurgitation
apex, sound radiates to axilla
what is mitral valve prolapse
leaflet balloon back into atrium during systole
most common valve problem
MVP
does MVP occur more in women or men
women
what test is used to Dx MVP
echo
treatment method for MVP
control symptoms
avoid alcohol, caffeine, tobacco
will a with who has MVP and CP respond to nitrates
No
MVP s/sx
commonly asymptomatic
fatigue
SOB
lightheaded, dizzy
syncope
palpitations
what is aortic valve stenosis
obstructive blood flow from L ventricle to aorta during systole
aortic valve stenosis can lead to what
L ventricular hypertrophy
aortic valve stenosis s/sx
angina
syncope
DOE
HF
diminished or prominent S4
where is an S4 heard with aortic valve stenosis
R 2nd ICS
lean forward, exhale
what can occur with progressive aortic stenosis
decrease tissue perfusion
pulmonary HTN
HF
what occurs with atrial regurgitation
back flow of blood into L ventricle from aorta during diastole
what is 2 diseases are results of atrial regurgitation
pulmonary HTN
R CHF
what is a diastolic murmur heard with atrial regurgitaiton
3rd or 4th ICS at LSB
what are the causes of acute atrial regurgitation
trauma
IE
aortic dissection (life threatening emergency)
acute atrial regurgitation s/sx
abrupt onset of:
CP
dyspnea
L ventricular failure
cardiogenic shock
chronic atrial regurgitation s/sx
fatigue
DOE
orthopnea
nocturnal dyspnea
water hammer pulse (Corrigan’s pulse)
what is water hammer pulse (Corrigan’s pulse)
bounding, forceful pulse with rapid upstroke and descent
which artificial valve last longer: mechanical or biological
mechanical
which artificial valve requires lifelong anticoagulation therapy: mechanical or biological
mechanical
how long can a biological valve last
7-15 years
what are the 4 types of biological valves
bovine (cow)
porcine (pig)
equine (horse)
homograft/allograft (cadaver)
